Paver/Brick Order Form

Paver/Brick Order Form

Purchaser's Name _________________________ ___________________

Phone Number  _________________________ _____________

Engraving (20 characters per line):

_______ 4" x 8" paver with three lines for $200.00

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_______  8" x 8" paver witih six lines for $350.00

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I have reviewed the above and it meets with my approval:

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Date

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Signature

Amount Paid with Order: $ _________________

Balance Due:  $ ____________